PCORI implementation projects promote the use of findings from PCORI-funded studies. The initiative on Implementation of Effective Shared Decision Making Approaches in Practice Settings funds projects like this one to promote the use of shared decision making strategies tested in PCORI-funded studies or incorporating evidence from PCORI-funded research, to support patients in making informed decisions about their care.
COVID-19-Related Project Enhancement
The COVID-19 pandemic has resulted in a widespread halt for non-urgent visits and postponed non-urgent surgical procedures, which affects the care and treatment of patients with symptomatic uterine fibroids. However, with the relaxation of HIPAA regulations and changes in payment models to allow for telehealth, many health systems are shifting to audio and video conferencing platforms to continue care for patients.
The enhancement aim for this project promotes shared decision making in the pandemic-related change to telehealth for patients with uterine fibroids by making a decision aid available to patients remotely. The project team will work with each site to tailor the adapted pathway to meet the needs of their clinic workflow.
Enhancement Award Amount: $499,970
This project is in progress.
What were the results from the original PCORI-funded research study?
Uterine fibroids are growths in the uterus that are not cancer. They are a common health problem and can cause heavy bleeding, pain, problems with pregnancy, and preterm birth. The PCORI-funded research study compared three ways of treating uterine fibroids. All three treatment options worked about the same to prevent or delay new or recurring symptoms. Two treatments—surgery to remove fibroids and uterine artery embolization, a procedure to block the flow of blood to fibroids—were better at helping patients avoid follow-up treatment compared to the third, endometrial ablation, which removes a layer of the uterus lining. Each option has trade-offs, such as cost, recovery time, or effect on fertility.
Why is this research finding important?
Patients and their doctors need information about the benefits and harms of each treatment to make a choice that best matches each patient’s goals.
What is the goal of this project?
The project team is working with health centers to make shared decision making part of regular care for patients with fibroids. Shared decision making is a process where patients and doctors make decisions together based on the patient’s individual needs. The shared decision making process the team is developing will allow patients and doctors to discuss the evidence on benefits and risks of the three types of fibroid treatment.
What is the project team doing?
Using results from the research study, the project team is updating materials that health centers can use to make it easier for patients and doctors to make shared treatment decisions about fibroids a part of care:
- A survey for health centers. Staff can take the survey to assess how ready they are to help patients and doctors make shared decisions about fibroid treatments. The project team is helping each health center prepare to use the decision aids based on the survey results.
- Decision aids for patients about fibroid treatment. The team is updating two decision aids, called Option Grids, which help doctors and patients compare and talk through treatment options.
- Training for doctors. The team is training doctors in how to work with patients to make treatment choices together.
The project team is working with five health centers around the country. At each health center, at least five doctors are getting the training and using the materials when talking with patients about fibroid treatment. Patients may review the decision aid on their own ahead of time and again at their appointment. The decision aid is available in English and Spanish.
How is the team evaluating this project?
The project team is using patient surveys to compare patients’ care and their health choices before and after each health center starts using the updated decision aids. The team is looking at
- How often patients and doctors make shared decisions about fibroid treatment
- Patients’ symptoms after fibroid treatment
- What health services women use after fibroid treatment
In addition, the team is measuring how often patients and doctors use the decision aids together. They want to see whether making shared decisions becomes part of the regular process for treating fibroids at each health center.
How is the team involving patients and others in making sure the findings reach people who can use them?
Patients, doctors, the Fibroid Foundation, and the National Uterine Fibroids Foundation are working with the project team to improve the decision aids and other materials. The team is working to make the decision aids part of an online resource system that hospitals and doctors can use to share materials with patients.
Learn more about PCORI’s Dissemination and Implementation program here.
Related PCORI-funded Research Project
Note: Results from the original project have completed PCORI’s Peer Review and are available here.